title: Twenty-four-month continuation of reversible contraception.
abstract: OBJECTIVE
  To estimate 24-month continuation rates of all reversible contraceptive methods for women enrolled in the Contraceptive CHOICE Project.
  
  
  METHODS
  We analyzed 24-month data from the 9,256 participants enrolled in the Contraceptive CHOICE Project, a prospective observational cohort study that provides no-cost contraception to women in the St. Louis region. The project promoted the use of long-acting reversible contraception (LARC) (intrauterine devices [IUDs] and implants) in an effort to reduce the rates of unintended pregnancy. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who completed a 24-month follow-up survey (N=6,153).
  
  
  RESULTS
  Twenty-four month continuation rates for long-acting reversible contraception and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% compared with 77%), whereas the implant continuation rate was significantly lower (69%, P<.001) compared with IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill [OCP] 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate [DMPA] 38%; P=.72). Participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation (adjusted hazard ratio 0.29, 95% confidence interval 0.26-0.32) compared with women who selected a non-LARC method.
  
  
  CONCLUSIONS
  Intrauterine devices and the implant have the highest rates of continuation at 24 months. Given their effectiveness and high continuation rates, IUDs and implants should be first-line contraceptive options and shorter-acting methods such as OCPs, patch, ring, and DMPA should be second tier.
  
  
  METHODS
  II.
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Micaela
authors.initials: M
authors.lastname: O'Neil-Callahan
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Zhao
authors.forename: Tessa
authors.initials: T
authors.lastname: Madden
authors.forename: Gina
authors.initials: G
authors.lastname: Secura
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D007435:Intrauterine Devices, Copper / Q000706:statistics & numerical data; D016912:Levonorgestrel / Q000008:administration & dosage; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D010298:Parity; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate